A Randomized Cross-Over Trial of the Postprandial Effects of Three Different Diets in Patients with Type 2 Diabetes

Abstract

BackgroundIn the clinic setting both fasting levels of glucose and the area under the curve (AUC) of glucose, by determination of HbA1c levels, are used for risk assessments, in type 2 diabetes (NIDDM). However little is known about postprandial levels, and hence AUC, regarding other traditional risk factors such as insulin and blood-lipids and how this is affected by different diets.ObjectiveTo study postprandial effects of three diets, during a single day, in NIDDM.MethodsA low-fat diet (45–56 energy-% from carbohydrates), and a low-carbohydrate diet (16–24 energy-% from carbohydrates) was compared with a Mediterranean-style diet (black coffee for breakfast and the same total-caloric intake as the other two diets for lunch with red wine, 32–35 energy−% from carbohydrates) in a randomized cross-over design. Total-caloric intake/test-day at the clinic from food was 1025–1080 kCal in men and 905–984 kCal in women. The test meals were consumed at a diabetes ward under supervision.ResultsTwenty-one participants were recruited and 19 completed the studies. The low-carbohydrate diet induced lower insulin and glucose excursions compared with the low-fat diet (p<0.0005 for both AUC). The insulin-response following the single Mediterranean-style lunch-meal was more pronounced than during the low-fat diet lunch (insulin increase-ratio of the low-fat diet: 4.35±2.2, of Mediterranean-style diet: 8.12±5.2, p = 0.001) while postprandial glucose levels were similar. The increase-ratio of insulin correlated with the elevation of the incretin glucose-dependent insulinotropic-polypeptide following the Mediterranean-style diet lunch (Spearman, r = 0.64, p = 0.003).ConclusionsThe large Mediterranean-style lunch-meal induced similar postprandial glucose-elevations as the low-fat meal despite almost double amount of calories due to a pronounced insulin-increase. This suggests that accumulation of caloric intake from breakfast and lunch to a single large Mediterranean style lunch-meal in NIDDM might be advantageous from a metabolic perspective.Trial RegistrationClinicalTrials.gov NCT01522157 NCT01522157

Lower carbohydrate and higher fat intakes are associated with higher hemoglobin A1c: findings from the UK National Diet and Nutrition Survey 2008–2016

“…It has been hypothesized that lower postprandial glucose excursion on a low-carbohydrate, high-fat (LCHF) diet may lead to a better glucose control [7,8]. LCHF diets have been promoted as a possible strategy for the management and prevention of T2DM, but there is no consensus on the best macronutrient composition [9].…”

Dieta low carb como estratégia de manejo na remissão do diabetes mellitus insulinorresistente: síntese de evidências

“…Dessa forma, os autores concluíram que existem efeitos benéficos em ambas as dietas oferecidas, embora estes tenham sido mais pronunciados nos indivíduos portadores de DM tipo II que receberam a dieta LC. Fernemark et al (2013), compararam por meio de um estudo cruzado e randomizado, uma dieta com baixo teor de gordura (45-56% de energia vinda dos carboidratos), e uma dieta LC (16-24% de energia vinda dos carboidratos), com uma dieta de estilo mediterrâneo. Dos 21 pacientes portadores de DM tipo II inicialmente recrutados, 19 completaram o estudo.…”

A Review of the Relationship between Wine Consumption and Type 2 Diabetes Mellitus

“…The optimal amount of wine appeared to be approximately two drinks/day, where a standard drink in Australia is considered to be 10 g alcohol [34]. Wine consumed with food, and especially as an integral component of Mediterranean-type diet, was inversely associated with type 2 diabetes mellitus [35][36][37]. The inverse association was particularly observed for overweight and obese individuals at higher risk of developing the disease [32,33,35], in middle-aged individuals [17,38] and in elderly individuals [30,39].…”

“…Micro-vascular and other complications of type 2 diabetes mellitus were also inversely associated with regular moderate wine consumption [24,29,36,[45][46][47][48][49][50]. Beulens et al (2010) [48], for example, suggested that one to two drinks/day as wine was associated with a reduced risk of vascular-related deaths such as from coronary heart disease, myocardial infarction and stroke as well as non-fatal events including amputations in diabetic individuals at high risk of cardiovascular disease compared to abstainers.…”